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Author Topic: unilateral patellar and trochlear ACI - 4/27/07  (Read 25455 times)

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Offline djs60

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Re: unilateral patellar and trochlear ACI
« Reply #30 on: October 04, 2007, 06:38:43 PM »
well I got the report on the MRI I had the weekend.

Overall report very good.  I was told the grafts have filled in very well and are flush with the surrounding cartilage.  No overgrowth evident.  No bone marrow edema underlying the grafts.

He did say something about some scarring in the suprapatellar area (or was it the infrapatellar area?  I'm not sure - should have written it down!).  He said something about that possibly contributing to my recent swelling/stiffness/discomfort.

Anyway, I see the surgeon again on the 31st, so will hope that my knee gets back to feeling as good as it did 4 weeks ago by then.

djs60
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO

Offline David3

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Re: unilateral patellar and trochlear ACI
« Reply #31 on: October 05, 2007, 12:14:12 AM »
Great news DJS!  Given that the fundamentals are all looking good, I'm sure you'll be making good progress again in no time. Keep us posted.

David
2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

Offline erinee

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Re: unilateral patellar and trochlear ACI
« Reply #32 on: October 06, 2007, 05:39:20 PM »
Excellent news.  A minor setback, then.
37 year old physical therapist, Left lateral release '92, bilateral debridement and scope '04, bilateral patellar cartliage defects, denied ACI repeatedly by insurance.  Scope and debridement 12/06 L knee.Bilat patellar ACI with Fulkerson 4/23/07.

Offline djs60

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Re: unilateral patellar and trochlear ACI
« Reply #33 on: November 01, 2007, 05:36:40 PM »
I saw my OS for my 6 month f/u visit yesterday.  He seemed happy with my progress overall.  We reviewed the MRI I had a month ago when I noted more stiffness & swelling.  The grafts (tochlear & patellar) look good.  There is some bone marrow edema in the patella under the graft, but none under the trochlear graft.  There is mild scarring of the soft tissues in the suprapatellar area and mild to moderate scarring infrapatellar area, but the OS felt the patella moved very well, so he wasn't concerned.  He didn't think the scarring accounted for the stiffness I have been complaining about.

He wants me to continue to slowly advance my activity, and I will see him again in 6 months (repeat MRI then).

He didn't think I needed any more formal PT at this point, so I will be transitioning to work on my own on building my quad strength.

djs60
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO

Offline djs60

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Re: unilateral patellar and trochlear ACI
« Reply #34 on: December 26, 2007, 06:56:57 PM »
8 Month update:

I continue to make slow progress.  Yesterday, I rode my bike to/from the gym (9.3 miles total), did my leg strengthening workout, and then did a 3.3 mile walk later in the day.  Knee feels OK today - no pain, probably just a little swelling.

On the other hand, I tried to cross country ski the other day, and my knee did not like that.

My plan for now is to continue to try to get all the bulk/strength back in my left quad, and to continue to slowly increase my activity level.

I'd like to be riding my bike more by April (one year).  Long term, I'd love to be able to run a little, but my OS told me I couldn't even consider that until 1.5 years post op.

Happy New Year,
djs60
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO

Offline Peg Leg

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Re: unilateral patellar and trochlear ACI
« Reply #35 on: December 27, 2007, 03:34:56 AM »
Djs,

Slow and steady wins the race! ;D Glad to hear of the progress you are making; keep it up!

Happy New Year!  Peg Leg
10/06  Miicrofracture Rt knee on mfc
defect was 1.3x2, small defect under patella
04/07 Arthroscopy/Cell harvest for Carticel
06/28/07 Carticel surgery ,Rt. Knee
12/27/07  Scope to debride Patella lesion,Rt. Knee
4/17/08  Fulkerson AMZ, Rt. Knee
6/25/09 ConforMis BiCompartmental Knee Replacement

Offline djs60

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Re: unilateral patellar and trochlear ACI
« Reply #36 on: February 02, 2008, 04:32:23 PM »
9 month update:

Things continue to improve, which is encouraging.

At this point, I am riding my stationary bike 25 to 30 minutes at moderate resistance.  I rode my rode bike for about 12 miles last weekend, and it didn't seem to aggravate my knee at all.  I continue to go to the gym 2 to 3 times a week to try to build leg strength with weights.

I don't notice any swelling of the knee at this point, which is a change.  My OS had told me to expect some swelling given it's a patellofemoral ACI for up to 9 months, so I seem to be following that prediction.

My plan for the next 30 days is to increase my biking somewhat, and to continue to try to get my left quad to look more like the right!

Hope everyone else is also making steady progress in your recoveries!

djs60
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO

jonhark

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Re: unilateral patellar and trochlear ACI
« Reply #37 on: March 13, 2008, 12:07:00 AM »
Hey DJS--

You are about four months ahead of me on your patella aci rehab. Out of curiosity, did you ever have heat in your knee along with swelling.

I have really no swelling but continue to have some heat coming from the knee. My OS says it is due to inflammation...which has me a little worried.

At seven months I'm able to bike and do light weights with no problem. My knee does bark when I overdo it though.

How is your knee feeling these days?

Thanks in advance for your feedback.

JonHark

Offline djs60

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Re: unilateral patellar and trochlear ACI
« Reply #38 on: March 13, 2008, 01:49:49 AM »
Hi JonHark,

It's kind of up and down.

Two weeks ago, the knee felt fabulous.  I was wondering if the OS might let me try running when I see him for my one year visit next month.

But now I again have some stiffness & swelling.  I had tried doing some riding outside on my bike - nothing too dramatic, just 10 or 20 miles at a very easy pace.  I had also had a minor mishap where I slipped and had a very sudden deceleration that caused brief but intense pain in the patella, so not sure if that's playing a role.

So, I clearly still have some inflammation in there at this point.  It is better today than yesterday, so I don't think it's anything terrible.

To answer your question, my pattern has been to get some swelling when I overdo it, but I don't really notice warmth. 

How much biking are you able to do?

I am scheduled to have an MRI and followup visit on 4/17, so I will certainly post an update then.

Dan
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO

jonhark

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Re: unilateral patellar and trochlear ACI
« Reply #39 on: March 13, 2008, 02:36:19 AM »
DJS--Based upon what your lesion sizes were and the fact you had kissing lesions...I'd say you are doing really well.

I have yet to bike outdoors yet--only on a spin bike in the gym with the seat way back and high. I did 25 minutes the other day with no pain. I actually cranked on the pedals a little bit instead of simply spinning.

That in conjunction with a week on the beach walking in Florida and standing all day at a conference has caused some tenderness this week. I haven't done any PT this week and the pain seems to be dissipating. My guess is there is bone edema causing my discomfort.

I really don't have any swelling to speak of but do have the heat throughout the day. It is really bizzare....

My OS isn't too worried as the patella is so much tougher to get a good cartilage fill than the femur as it is 5mm vs. 3mm. He doesn't seem to think ill have these problems in 3-4 months.

How would you rate your progress from 7 to 9 and 12 months?

Offline djs60

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Re: unilateral patellar and trochlear ACI
« Reply #40 on: March 13, 2008, 02:45:56 AM »
Jon,

Maybe it's the indoor/outdoor bike thing.  I can do 25 or 30 minutes on an indoor bike at moderate intensity with no issues, but riding a real bike outdoors seems to stress the knee more.

You are probably right about the patella v. the femur.  At my Oct MRI (so 5.5 months postop), I had no edema under the trochlear graft, but some under the patella.  My OS pointed out the same thing to me about the relative thickness of the cartilage, and stressed that the patella just takes longer.

I'm at 10.5 months now, and I would say it's definitely better than at 7-8 months, but honestly i'd call it incrementally better, not dramatically better.

I'm actually feeling pretty positive; I think I'm having the normal ups and downs that go with this surgery and rehab.
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO

Offline djs60

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Re: unilateral patellar and trochlear ACI
« Reply #41 on: April 17, 2008, 11:38:07 PM »
Today was my one year followup visit for my aci trochlea/patella and TTO (surgery was 4/27/07, so I'm one week short of a year).

I had an MRI prior to the visit then met with the OS to review it.

He seemed very pleased with the MRI.  He said the fill of the graft sites was very good, and the signficant edema under the patella seen on the 6 month post op MRI had nearly totally resolved.  There is some scarring medial & lateral to the patella, which he said could account for the slight stiffness I notice, but he said the patella moves so well that he wouldn't consider doing anything about that at this point.

I asked him if he would let me run again, and he told me he would see me again in 6 months with repeat MRI, and that if things looked good then he would consider letting me run.

I still don't have normal muscle bulk in my left quad, so I am going to redouble my efforts to build that up.

I have been biking more lately (50 miles a week), and the knee seems OK with it, which is encouraging.

The OS told me today he expects the cartilage to improve for at least another year.

So, all in all I am feeling pretty good about the knee!

djs60
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO

Offline Army John

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Re: unilateral patellar and trochlear ACI
« Reply #42 on: April 18, 2008, 01:31:32 AM »
Great news!

John
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08

Offline David3

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Re: unilateral patellar and trochlear ACI
« Reply #43 on: April 18, 2008, 03:09:06 AM »
Good stuff DJS. Hope your progress continues.

Can I ask how hard you are cycling? What sort of gears are you pushing on the flat? Are you doing hills?

David
2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

Offline djs60

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Re: unilateral patellar and trochlear ACI
« Reply #44 on: April 18, 2008, 03:56:31 AM »
David,

I'm not cycling very hard.  This past weekend, I rode 20 miles at an average of 15 mph.  I have a triple on my road bike (I think the front rings are 52/42/32), and I think my rear cluster is 13-23.  I was mostly on my middle ring, but used the little one a couple of times.  No big hills, but some little ones. 

I've ridden to work a couple of times this week (20 miles round trip), and the knee feels good, so I feel like I've made a bit of a step forward.

Dan
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO















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